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Determination of Highly Resource-Intensive Pediatric Patients: Opportunity for Innovation

Josiah Yarbrough1, Juliana Perl2, Kunj Sheth3

  • 1Stanford University School of Medicine, Stanford, CA; Stanford Mussallem Center for Biodesign, Stanford University, Stanford, CA.

The Journal of Pediatrics
|November 15, 2025
PubMed

Insights

Resource-intensive pediatric diagnoses like perinatal syndromes and cancers lead to higher complication rates. Insurance type impacts resource use, highlighting opportunities for targeted care management in children's hospitals.

Area of Science:

  • Pediatric Health Services Research
  • Healthcare Economics
  • Clinical Informatics

Background:

  • Identifying high-cost diagnosis-related groups (DRGs) is crucial for optimizing resource allocation in pediatric hospitals.
  • Understanding patient outcomes and payor patterns associated with resource-intensive care is essential for improving healthcare value.

Purpose of the Study:

  • To identify the most resource-intensive diagnosis-related groups (DRGs) in children's hospitals.
  • To analyze patient outcomes, including clinical complications, for these high-resource DRGs.
  • To examine the distribution patterns of payors for resource-intensive pediatric inpatient encounters.

Main Methods:

  • A retrospective cohort study analyzed 359,616 pediatric inpatient encounters from 39 tertiary-care children's hospitals (2023).
  • Resource intensity was determined by length of stay, billed charges, and cost-to-charge ratios.
  • Top twenty DRGs for each metric were classified as most resource-intensive; clinical complications and payor patterns were secondary outcomes.

Main Results:

  • Perinatal syndromes (57.5%), oncologic conditions (5.8%), and musculoskeletal disorders (4.4%) were the most resource-intensive DRGs.
  • Resource-intensive encounters had significantly higher rates of complex chronic conditions (72%-94%) and complications compared to the general population.
  • Patients with Children's Health Insurance Program and commercial PPO insurance had higher risks of resource-intensive care, while Medicaid Managed Care and commercial HMO plans showed protective effects.

Conclusions:

  • Perinatal syndromes, oncologic conditions, and musculoskeletal disorders represent the most resource-intensive pediatric diagnoses.
  • These high-resource diagnoses are associated with increased complication rates and varying payor utilization.
  • Targeted care management strategies for high-resource diagnoses could enhance the value of pediatric hospital care.
Abstract

Keywords:
medical innovationmedical technologyneonatologyresource utilizationvalue-based care

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